Kumar Lokesh S, Keluskar Vaishali, Naik Zameera
Department of Oral Medicine, Radiology and Special Care Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS Deemed-to-be University), Chennai, India.
Department of Oral Medicine and Radiology, Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research (KAHER Deemed-to-be University), Belagavi, India.
Dent Med Probl. 2024 Mar-Apr;61(2):301-306. doi: 10.17219/dmp/127639.
Actinomycotic osteomyelitis is a rare chronic suppurative, granulomatous, fibrosing saprophytic infection. It is an endogenous infection caused by the Actinomyces species, which are part of the normal oral microflora. There is a male predilection for this type of infection, with the male to female ratio of 4:1. Though the etiopathogenesis of the infection is unclear, it is mostly attributed to the disruption of the normal oral microflora and the invasion of the microorganism into deeper tissues through a break in the mucosal barrier due to damage from trauma, extraction or previous injury. The portal of entry can be through the pulpal, periodontal or mucosal route, causing the purulent and necrotic infection of soft tissue, bone, or both. The diagnosis is usually considered when there is a persistent infection without the presence of regional lymphadenopathy and is usually confirmed through the histopathological depiction of the bacterial colonies - 'ray fungus' - as obtaining the positive culture of the causative microorganisms is difficult and is reported to be effective in less than 50%. Patients with such infections are managed with surgical debridement, followed by antibiotic therapy for a longer time period. Recent advances have been emphasized for an early diagnosis and a better prognosis of the therapy. Therefore, this paper aimed to present a rare case of actinomycotic osteomyelitis of the maxilla in a 45-year-old female patient, and also to review the literature on this rare infection.
放线菌性骨髓炎是一种罕见的慢性化脓性、肉芽肿性、纤维性腐生感染。它是由放线菌属引起的内源性感染，放线菌属是正常口腔微生物群的一部分。这种类型的感染男性更易患病，男女比例为4:1。尽管感染的病因发病机制尚不清楚，但主要归因于正常口腔微生物群的破坏以及微生物通过创伤、拔牙或先前损伤导致的黏膜屏障破损侵入更深层组织。感染的入口可以通过牙髓、牙周或黏膜途径，导致软组织、骨或两者的化脓性和坏死性感染。当存在持续性感染且无局部淋巴结病时通常考虑诊断，通常通过细菌菌落（“放线菌”）的组织病理学描述来确诊，因为获得致病微生物的阳性培养困难，据报道成功率低于50%。此类感染患者通过手术清创治疗，随后进行较长时间的抗生素治疗。近期进展强调了早期诊断和更好的治疗预后。因此，本文旨在介绍一名45岁女性患者上颌骨放线菌性骨髓炎的罕见病例，并回顾关于这种罕见感染的文献。
